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Experts diagnose documentary, ‘Sicko’ by Holly Auer Of The Post and Courier Throughout the past three weeks, moviegoers nationwide have packed theaters to take in a documentary skewering the American health care system, a rather unlikely topic for a top-grossing summer film.   But last week, Michael Moore’s “Sicko” remained among the nation’s Top 10 films, beating out the glam, star-laden “Ocean’s Thirteen” but coming in a few notches behind the off-color heartwarmer “Knocked Up.”   The Post and Courier rounded up a group of Medical University of South Carolina health care workers and asked them to go see the movie, which has polarized viewers. There’s ire from conservative groups that call it anti-American, marches by fed-up nurses supporting the film’s message, dismissal by politicians who say it’s too short on solutions to be taken seriously, and heaps of “me, too!” stories from the everyday folks who’ve gone to see it.   But putting the controversy aside, the doctors and nurses we talked to say they’re just pleased to see how much dialogue the film has sparked about the issue, warts and all.   They mostly agree that the American way of providing medical care is indeed sick, beset by out-of-control costs, glitzy ads that make patients push their doctors for drugs they might not need and labyrinthine insurance rules governing who pays for what care and when.   Among the most pressing issues: how to provide for the nearly 50 million Americans without any health insurance at all. Some candidates for the 2008 presidential election are crafting plans for universal health care coverage, while others are calling for greater oversight of the way insurance companies do business.   Those who work in the field see the results of system breakdown every day, and they want change, too.   “We definitely have got to become a country where everyone has access to care, and people can’t be completely devastated because they get sick,” says Natalie Ankney, MUSC’s Heart and Vascular Center nurse manager. Care for all In the tradition of his other films, Moore moves “Sicko” along through a cherry-picked collection of anecdotes that best support his thesis: evil insurance companies employing a band of well-paid people to deny you treatment are making you sick. Meanwhile, he asserts, our neighbors to the north and across the pond are flourishing in the loving care of a robust medical care system paid for solely by the government.   And he tantalizes viewers caught in a landslide of inflating drug costs and premiums with the constant reminder that in those places, every doctor’s visit and hospitalization are free, and medications cost a mind-bogglingly tiny price.   But Moore’s is no C-SPAN camera, capturing all the dry policy details and problematic issues that make health care reform such a tough nut to crack. In fact, notes MUSC President Dr. Ray Green-berg, it’s not even “Anderson Cooper 360,” the jazzed-up, Gen X-grabbing nightly news magazine.   This isn’t to say that Moore’s film is a reel of fiction. He does cast attention on pressing problems, especially those that affect the elderly and terminally ill. It’s just that it seems “there’s always more to the story than what he tells,” said Dr. Patrick Cawley, executive medical director of the MUSC Medical Center.   As a physician who has cared for just about every type of hospital patient, he knows that most sick people have a complex story that can’t be told in a 30-second, horror-filled snippet.   Take the clip that opens the movie, of a guy with a nasty gash in his leg executing a home-stitching job on the wound because, we’re told, he has no insurance. Did he try to get professional help first, or is he just hamming it up for his buddies? Moore doesn’t tell us. Health care workers say, though, that they’re bound by law to treat emergencies regardless of a patient’s ability to pay. Clogged ERs are common nationwide, so both insured and uninsured people likely will have to settle in for a lengthy wait to be seen, but there’s not supposed to be someone barring entry for those who can’t produce an insurance card.   “You were raised and taught that that is your responsibility,” said Dr. Keith Borg, an emergency room physician at MUSC. “There’s very much a culture that you’ll see and treat everyone. You don’t do a wallet biopsy before you see someone.” Government control “Sicko” takes viewers along as Moore crosses the globe to countries that provide nationalized health care, from France and England to Canada and Cuba. Moore chats with doctors about whether the system has eaten into their hearty paychecks, grills residents about whether they’re strangled by huge taxes and trolls hospital waiting rooms to see if anyone complains about their care. No, no and no come the answers. Doctors, in fact, often are paid extra for doing “the right thing” for patients, regardless of the cost.   But the picture Moore paints of these medical systems is undeniably oversimplified, and the mere word “socialized” is heavily loaded, Greenberg said. But as Moore points out, plenty of other entities Americans rely on each day—the Postal Service and public libraries, for examples—already are run by government.   And, in fact, a huge chunk of U.S. citizens already get their health care from the government through Veterans Affairs or other programs such as the federal State Children’s Health Insurance Program, which pays for care to low-income children.   That VA system isn’t perfect, and waits to see specialty doctors are common. But the VA has been widely praised for its advances in the standardization of care and its efforts to build a robust electronic medical records system.   “Most vets are happy with it, and they probably don’t think of themselves as being in a socialized medicine system,” said Greenberg, who trained in pediatrics and has degrees in public health and epidemiology. “You don’t have to have the theater of Gitmo to make the point that there are some groups in this country getting care that way.”   But rather than look close to home for solutions that work, Moore hauled a boat of sick 9/11 emergency workers to Cuba to demand care at Guantanamo Bay’s high-tech prison hospital.   “They don’t want any more than they’re giving the evildoers—just the same,” he hollers to military guards through a bullhorn before retreating from the compound.   As a nation that prides itself on its bustling free market, Cawley is doubtful that the U.S. would ever adopt a truly single-payer system of providing health care. What he envisions, though, is a basic level of care—preventive check-ups, hospital care and low-cost drugs—available to everyone for free. Extra services and coverage, then, could be purchased from private insurance companies by people who wanted and could afford them.   Other bandages to the ailing system, doctors and nurses say, might include an electronic system providing doctors and hospitals access to patient records from anywhere in the nation (this could cut down on medical mistakes and costly drug duplication), passing more legislation such as motorcycle and bike helmet laws to reduce accident injuries and funding more preventive tests and care to treat diseases early. Costly decisions When allowed to dream a little, health care workers do say they wish cash were less a part of the care equation here. Some organ transplant patients, for instance, must prove that they have a large cash reserve on hand to pay for their surgery and aftercare before they can get the transplant.   “It’s sad that we’re a society that places some sort of value on a person’s life,” Ankney said.   And even middle-class, insured patients often shoulder enormous costs to take lifesaving medications, she says. Plavix, for instance, is a drug commonly used in patients who’ve had drug-coated stents placed to prop open clogged coronary arteries. Because there’s no generic equivalent available yet, out-of-pocket costs for a month’s supply can run around $400.   Pamela Smith, a pediatric emergency room nurse who also has a master’s degree in business administration, laments insurers’ short-sighted focus on the bottom line. Among preventive health care tests often not covered: Pap tests, which help screen for cervical cancer, and colonoscopies, which are proven to detect and prevent colon cancer.   Smith considers herself somewhat of a testament to the value of paying for risk-reducing care: She had gastric-bypass surgery several years ago and lost enough weight to help her wriggle free of the health problems that often accompany obesity. But these days, it’s much harder for patients to get the weight-loss surgery paid for, even if they’re headed for costly diabetes and cardiac care.   “Would they rather pay $100,000 for a coronary bypass 20 years down the road?” Smith wonders.   “Sicko” makes a compelling case that these knee-jerk denials and decisions are bad: harmful for you, harmful for your grandmother and harmful for the country at large. But the film perhaps begs for a sequel about what, exactly, ought to be done about it all. And maybe another one, if the audience is still buying, in which the lens widens to show some of the other players in the health care system.   Because there are bad doctors, too, and patients who don’t follow instructions or take care of themselves. And fast-food companies and snack manufacturers that raise the nation’s collective blood pressure and cholesterol levels. And tobacco companies and alcohol distributors who sell substances that can be addictive and make people sick.   In “Sicko,” though, Moore reserves his nastiest indictments for big pharmaceutical companies and the nation’s largest insurance companies.   “It’s easy to make them the villains in the story,” Greenberg says. “There’s plenty of ammunition there, but I think the picture is more complicated.” Editor’s note: The article ran July 16 in the Post and Courier and is reprinted with permission.     Friday, July 202007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. 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