BlueCross: "You would have to be dead to be unaffected by Moore's movie..."

MichaelMoore.com :From Michael Moore's website:

An employee who works at Capital BlueCross has sent us a confidential memo written and circulated by its Vice President of Corporate Communications, Barclay Fitzpatrick. His job, it seems, was to go and watch 'Sicko,' observe the audience's reaction, and then suggest a plan of action for how to deal with the movie.

The memo, which I am releasing publicly in this email, is a fascinating look at how one health care company views 'Sicko' -- and what it fears its larger impact will be on the public. The industry's only hope, the memo seems to indicate, is if the movie 'flops.'

Mr. Fitzpatrick writes: 'In typical Moore fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich.'

No. You don't say! That can't be!

BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just saw. 'You would have to be dead to be unaffected by Moore's movie,' he writes. 'Sicko' leaves audiences feeling 'ashamed to be...a capitalist, and part of a 'me' society instead of a 'we' society.'

He walks out of the theater only to witness an unusual sight: people -- strangers -- mingling and talking to each other. "'I didn't know they (the insurers) did that!' was a common exclamation followed by a discussion of the example," according to Fitzpatrick.

He then assesses the film's impact: "[T]he impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of Moore's films ... If popular, the movie will have a negative impact on our image in this community."

The BlueCross memo then suggests a strategy in dealing with "Sicko" and offers the BCBS "talking points" to be used in discounting the film.

As regular readers will know, I'm a huge fan of SiCKO (recognizing it as what it is and is (mostly) meant to be, and not mistaking it for a dispassionate documentary mired in detail and obligatory, "on the other hands...").

Those threatened by the movie's central truths are well into their counterattacks, and Moore is pushing back. It can be tricky when Moore is put into the position of a "talking head" expert suitable for the NewsHour, which IMHO does not suit his particular gifts (indeed, genius). But when the opposition mounts its own polemics and irrelevancies (since they have very little large substantive truth to fall back on--our existing system is both terminally ill and grossly immoral), so that Moore can mount a counter-offensive, he can be quite effective. This is one example; there will be more.

The insurance executive's letter is, needless to say, worth reading in full on Moore's website.

Health Care Terror

New York Times: By Paul Krugman

That’s what we learn from the overwhelming response to Michael Moore’s “Sicko.” Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn’t focus only on self-interest. They should also appeal to Americans’ sense of decency and humanity.

What outrages people who see “Sicko” is the sheer cruelty and injustice of the American health care system — sick people who can’t pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn’t a participant in her mother’s health plan won’t treat her, hard-working Americans driven into humiliating poverty by medical bills.

“Sicko” is a powerful call to action — but don’t count the defenders of the status quo out. History shows that they’re very good at fending off reform by finding new ways to scare us. ...

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result — but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here.

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American — and much better than that of uninsured Americans, many of whom never receive needed care at all. ...

“We have always known that heedless self-interest was bad morals; we know now that it is bad economics.” So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

What is it that our fellow citizens, almost uniquely among the people of the world, can't seem to get about this? It isn't that hard. What is wrong with us?

"Sicko" Vs. A Sick Show

TomPaine.com:By Isaiah J. Poole

...The real choice, as 'Sicko' makes clear, is between a radical rethinking about how the nation views health care—as a right of every individual rather than a commodity to be bought and sold—and the perpetuation of a system that impoverishes the many for the profit of the few. There is an army, led by Bush, that wants to put window dressing on a fundamentally dysfunctional system, one that measure after measure shows is leaving Americans with a lower life expectancy and higher infant mortality—but higher costs—than many other developed countries that, yes, 'put more power in the hands of government.'...

Some critics are blasting Moore for painting an overly utopian picture of health care in Canada, Great Britain, France and Cuba. But the critics dodge the fundamental difference between health care in those countries and health care in America: the difference in values. In America, while charity is good, the bottom line is each person's health care is their responsibility. You're on your own. In the countries that Moore examines with universal care, health care is a shared responsibility, and the notion that everyone pays into a system that provides for the needs of everyone is not any more questioned than is the concept in America that we all pay for the military and police services that protect us all.

That is the broader discussion that "Sicko" promotes, not just what should we do about the 49 million uninsured in America but what do we do about the overwhelming majority of Americans who have health insurance but do not have health assurance—who could find, as I did recently, that a doctor can prescribe a medical procedure to protect your health, but, to borrow Bush's words, "an insurance bureaucrat can make medical decisions."

TWB on The problem with Michael Moore's policy ideas

Slate Magazine: (Response to article by Austan Goolsbee --click link for original)

I don't know much about Austan Goolsbee. He describes himself as a "free market type" and as an economic advisor to Barach Obama. He largely agrees with the initial "critique" half of Michael Moore's Sicko, but then savages Moore's policy prescriptions. Some of his points are legitimate, and important: every health care system has to make some decisions about what care to provide, and moving from an existing system to a new one will involve significant transitional complexities that need to be taken into account. Fine. But Goolsbee's use of these fundamentally correct (if hardly novel) insights runs aground on a litter of straw men and Republican-style talking points.

I don't have time or energy to essay a point by point rebuttal of Goolsbee's particulars, but let me try a couple of key issues.

The US spends a far higher percent of GDP on health care than anyone else. The only country that comes close is Canada, and that is far behind. No one contends that the US population would be happy with a health care system funded at the level of Britain's NHS. That argument is a straw man. But if we were able to reduce our expenditures to a percent of GDP akin to Canada's, we could devote hundreds of billions of dollars to making access to reasonable care universal.

Would doctors earn less money under a single payer, universal system? Probably, although the effects would vary by specialty and plan design. Many experts argue that a more salary-based system would (and should) favor primary care providers relative to subspecialists currently highly compensated for performing large numbers of expensive procedures. It is not clear that this should be counted against a universal system. Many think it would improve the mix of physicians and the quality of most patient-physician encounters.

Would drug companies make less money in a universal payer system? Yes, as they do with the VA system, and in most deals they make with large buyers. A moment of silence, please. Would this affect innovation? Perhaps so. It might also affect (downward) marketing expenses for direct to consumer advertising and the variety of thinly veiled bribes to some physicians. Again, should this be counted as a negative? Why?

Malpractice issues? Puh-leez. This is pure talking point drivel. The statistics make clear that in terms of overall health care costs, this is "rounding error" level. In fact, a system in which patients (and jurors) are better treated, less angry with the system, and feel in greater solidarity with fellow patients may well reduce the incidence and the costs of malpractice claims.

Denial of service? Every health care system, absent an infinite budget, will need to "ration" some care in one form or another, whether directly and explicitly, or in a less direct and visible form. The method of rationing may be more or less rational (in something like cost-benefit terms) and more or less fair (allocated by medical need, or by ability to pay). A key truth is that the existing American "non-system" does both these jobs exceptionally poorly, and that tinkering around the edges is unlikely to make a great difference. One responsibility of a system of universal access/coverage will be to make these decisions in a more transparent, fair and accountable fashion. It is not that the current system is not already making these decisions; rather, insurance companies and HMOs are doing so behind closed doors, with little public accountability or sense of fairness. Michael Moore does an especially powerful job of revealing that reality.

A system of universal access to care will not magically do away with all hard choices and difficulties in the health care system. (Britain, France, Canada, Cuba, all counties continue to cope with the challenges of providing and paying for quality health care for their populations, and so will we.) It will provide a new, firmer foundation for a more just and efficient system, in place of the rotting timbers of what we now have. To return to Goolsbee's choice of metaphor, this junker is ready for the trash heap. I hope Barack Obama is not relying too heavily on his counsel.

The Rx From "SiCKO:" More Choice

Truthout: By Dean Baker

The pundits are working overtime trying to defuse the message from 'SiCKO,' Michael Moore's new film. They are trying to convince the public that the United States could not possibly do what every other rich country (and even some not so rich countries) have managed to do: guarantee their people decent health care.

The centerpiece of the pundits' whine is that universal health care could not work here. They claim the systems which work in other countries require a larger roll for government in health care than Americans want. While this claim is contradicted by poll after poll on the topic, we don't have to argue with the pundits, rather pointless task in any case.

We can just give people a choice and let them vote with their feet. Suppose the government were to establish a Medicare-type program and open it up to all individuals and employers in the country. Those who already have insurance can switch to the government-run plan. Similarly, employers can switch to it as well. Individuals who do not already have insurance would have the option of buying in to the expanded Medicare plan as would employers who do not currently provide insurance for their workers. We can also have a system of expanded subsidies for health care for low and moderate income households, which will make health care insurance more affordable for those families.

This is more or less what both John Edwards and Barack Obama have proposed in their presidential campaigns. To get to universal coverage, there are important issues like mandating that individuals have health care insurance, and also questions about the revenue source for subsidies, but the key point is to establish a national Medicare-type insurance system that can get costs under control and eliminate the enormous waste in the private insurance system.

Medicare's administrative expenses are a small fraction of the administrative expenses of private insurers. Medicare uses just 2 percent of the money that flows through the system to cover administrative costs. By contrast, private insurers spend between 10 to 20 percent of their premiums to cover administrative costs. They use this money for marketing, high CEO salaries and dividends to shareholders; all expenses that Medicare does not have.

This is the reason Medicare always wipes the floor when it competes against private insurers on a level playing field.

Michael Moore's Sicko reviewed

Slate Magazine:By Dana Stevens

Even those viewers who are ideologically in sync with Michael Moore can find plenty to critique in his methods: the gimmicks, the deck-stacking, the deliberate neglect of opposing points of view. On the other hand, even Moore's worst ideological enemies would be hard put to dispute the basic argument of his new film Sicko (Weinstein Co.): The American health-care system is a sick joke and has been for a very long time....

...[Moore's] chosen to focus on Americans who have insurance and find themselves screwed up the yin-yang anyway. This is a wise choice from a rhetorical point of view, because by exploring the dilemmas faced by those who have shoveled out premiums for decades, Moore can show that our status quo doesn't just have a few soft spots—it's rotten to the core....

In one of the movie's best segments, insurance-industry insiders frankly admit that their profession is rapacious. A former medical director for an HMO, testifying before Congress, delivers a scathing rebuke both of the insurance industry and of her own role in denying patients care. Another whistle-blower describes the industry's tactics with stark clarity: "You're not slipping through the cracks. Somebody made that crack and swept you toward it." A woman who does customer service for a major insurer weeps as she recalls denying sick customers coverage, then adds, "That's why I'm such a bitch on the phone to people. … I just can't take the stress."...

In a democracy, of course, complaining about something is doing something about it, as long as some of that griping is done at the polling booth. In that spirit, Sicko is less a documentary than a clearinghouse of rage.

I think this gets it right.

SiCKO is brilliant (and incredibly funny). See it now.

Michael Moore takes to the phones to promote Sicko

Slate Magazine: By Christopher Beam

The other day, a Slate staffer got a call from a person—a real, live person—asking if she planned to go see Michael Moore's new movie, Sicko. She said that she was indeed planning to see it but didn't know exactly when. The caller insisted that she go this weekend, to 'send a message' to the Bush administration that the country is fed up with the health-care system. What was this—an advertising campaign? Political mobilization? Some kind of Get-Out-the-Audience phone-a-thon?

All of the above. The Weinstein Company, Sicko's distributor, has hired a Democratic 'phone vendor' to contact a select group of potential moviegoers and encourage them to see the film. Phone vendors are usually employed by political campaigns and other interest groups to promote a candidate or a cause. But in this case, they just want you to watch a movie. They've already made 'tens of thousands' of live calls, with another slew of 'robo calls'—recorded messages read by Moore himself—on the way...

On the one hand, it's encouraging to see a studio believing that a film actually matters, and acting on that belief. But on the other, something troubles me about a major production company stealing a grass-roots campaign tactic. These callers aren't volunteers sharing their enthusiasm for a cause; they're getting paid to praise the virtues of universal health care. ... Even more disturbing is what this means for movie advertising. It's hard to imagine a scenario more horrific than Hollywood discovering telemarketing. ...

I'm on a do not call list, which I think protects me from unsolicited commercial (but not political) calls. Which is this?

Medical industrial complex LAUNCH SMEAR CAMPAIGN AGAINST MICHAEL MOORE

From Center for American Progress

In his new documentary SiCKO, filmmaker Michael Moore exposes the deplorable tactics practiced by some health insurance and pharmaceutical companies who deny coverage to individuals who are insured.
Moore is now facing "a multifaceted counteroffensive" from front groups supported and funded by the insurance and pharmaceutical industries. FreedomWorks, for example, recently launched a new campaign claiming that under policies favored by Moore, "healthy individuals" would "wind up subsidizing people like Moore, who are overweight and and/or live decidedly unhealthy lifestyles by frequenting fast-food restaurants, smoke, or use drugs."
Several health care industry members serve on the FreedomWorks board of directors, and the group is run by former House Majority Leader Dick Armey, whose PAC has received significant contributions from the health care industry.
The Cato Institute, which has written numerous pieces attacking Moore's film that argue that he "ignores the positive side of American health care," receives funding from multiple insurance and pharmaceutical companies, including Amerisure Insurance, Pfizer, and Merck. Additionally, a senior fellow at The Manhattan Institute, which receives funding from multiple pharmaceutical giants such as Bristol-Myers Squibb, started a site called Free Market Cure, which argues SiCKO is "set to inject a large dose of misinformation and propaganda into our national dialog about health care policy." Other health care industry front groups -- such as the Galen Institute, Pacific Research Institute, and the Heritage Foundation -- have also recently launched their own attacks on Moore's film.
The health insurance and pharmaceutical industries clearly view Moore's film exposing some of their misdeeds as a serious threat, and they have no shortage of funds to try to attack it.

There is a First Amendment.
While I have my doubts whether the Supreme Court's ready assimilation of corporations to "natural persons" and of commercial speech to core political speech were fully justified in the first instance, I favor robust debate on matters of public consequence--including the identification of the source of funding of such PR campaigns. I'm also curious about the tax treatment of money supporting such campaigns. Is such funding support regarded as a legitimate business expense or as a non-deductible political contribution-- or as a bribe?

Sicko

New York Times: By A.O. Scott

Yes, the utopian picture of France in “Sicko” may be overstated, but show me the filmmaker — especially a two-time Cannes prizewinner — who isn’t a Francophile of one kind or another. Mr. Moore’s funny valentine to a country where the government will send someone to a new mother’s house to do laundry and make carrot soup turns out to be as central to his purpose as his chat with Tony Benn, an old lion of Old Labor in Britain. Mr. Benn reads from a pamphlet announcing the creation of the British National Health Service in 1948, and explains it not as an instance of state paternalism but as a triumph of democracy.

More precisely, of social democracy, a phrase that has long seemed foreign to the American political lexicon. Why this has been so is the subject of much scholarship and speculation, but Mr. Moore is less interested in tracing the history of American exceptionalism than in opposing it. He wants us to be more like everybody else. When he plaintively asks, “Who are we?,” he is not really wondering why our traditions of neighborliness and generosity have not found political expression in an expansive system of social welfare. He is insisting that such a system should exist, and also, rather ingeniously, daring his critics to explain why it shouldn't.

I'm pretty much of an unreconstructed social democrat myself, as well as a longtime supporter of a single-payer, universal coverage system of health care. What more can I say?

Will Michael Moore's Sicko help or hurt the universal health care movement?

The New Republic: By Jonathan Cohn

As Sicko rolled, it did little to allay my fears. I spotted plenty of intellectual dishonesties and arguments without context--enough, surely, to keep right-wing truth squads (and some left-wing ones) busy for weeks. ...

Still, by the time the final credits ran, it was hard to get too worked up about all of that. Because, beyond all the grandstanding and political theater, the movie actually made a compelling, argument about what's wrong with U.S. health care and how to fix it. Sicko got a lot of the little things wrong. But it got most of the big things right. ...

[The Cato Institute's Michael] Tanner's op-ed was a good reminder of the proper context for considering Sicko--the fact that opponents of universal health care have been spewing half-truths and outright falsehoods for decades. If anything, the proponents of universal health care have probably been too honest, getting so caught up in nuance and policy accuracy that they undermine the very real moral power of their own argument. As another great health care debate begins, it's worth remembering that the fundamental challenge isn't technical. We have plenty of good ideas for achieving universal coverage. The challenge is political. Our side needs some passion and, yes, perhaps a little simplicity, too. That's what Moore has supplied. No wonder the health care industry is spooked.