Alright, I can’t help it – I just watched the new movie
Sicko, so I have to write about it. Labeled a propagandist
by some, self-contradictory by others, the value of Michael Moore’s
work is in its ability to get the public talking about a critically important
subject. And I must agree with the New York Times reviewer on this point – Sicko was the best
edited and most entertaining of Mr. Moore’s documentaries.
Socialized Medicine Won’t Work in the US (In My Humble Opinion)
was interesting for me because it compared the healthcare systems of the US, Canada,
France and Britain. Moore’s whole thrust is that socialized medicine is the
potential cure for America’s
healthcare crisis. I grew up in Canada,
spent summers in France,
trained in medicine in the US,
and my mom’s British – so I have a unique and very deep appreciation for the
cultural differences of these 4 countries. And here’s what I see: the way
a country cares for the sick is a reflection of their shared cultural
values. Each healthcare system has its own personality – like wine made
from grapes grown in the unique soil and climate of a specific region.
Even if you export the same vines to another place, the wine will never taste
the same. Let’s take a look at a few of these cultures (and yes I am
using somewhat stereotypical language to clarify the differences):
are fiercely individualistic. They are passionate, driven, and believe
that success is proportional to how hard you work. They believe in
survival of the fittest – if you’re not doing well, it’s probably your own
fault. Everything’s a competition, and capitalism spurs on a constant
parade of advertising, marketing, sales and consumerism, all orbiting the
almighty dollar and personal convenience. It’s critical to them that
anyone can attain the American dream – if they work hard enough. Fabulous
riches are within the grasp of any average Joe if he concocts a really good,
money-making business plan. Americans don’t have time for health prevention,
long vacations, taking care of others – no, they’re so busy working that only a
medical emergency will jar them out of their usual pursuits.
sort of healthcare system would grow out of this cultural milieu? A
hurried, high stakes, emergency intervention focused, technology driven
grab-all ruled by any stakeholder who can outsmart the competition.
Forget the poor, they’re not productive and don’t deserve equal care
really. But that financially successful “average Joe” will receive mind-blowing
technologically advanced care that costs hundreds of thousands of dollars and
can keep him alive long beyond any reasonable need to do so. Joe has a
shot at immortality, and somehow that makes all the work worthwhile. Yep,
that’s pretty much what the US
healthcare system is like.
are good natured and tolerant. They put the needs of others first.
They will pull over in a snow storm to help you change a tire, and then they’ll
have a beer with you and talk about hockey at a local pub after towing your
vehicle out of the ditch. They will also wait patiently and without
complaint for hours on end in a line for tickets or groceries, or whatever the
line is for. There are so few people in Canada (compared to the land mass)
that nothing feels crowded or busy. Their socio-political views lean
strongly toward socialism –almost no one is really rich or very poor in Canada.
Everyone is treated with the same friendly respect, living comfortably, no real
crime or racial tensions. What sort of healthcare system would these
socialized, government-run system that offers “free medical care” for all, with
insanely high taxes to cover it all. There are long lines, competent
doctors, and moderately satisfied patients.
French are argumentative and political. They tend to value
leisure above work, they don’t like rules imposed on themselves, and believe
that their government’s purpose is to serve their needs at all times.
They protest regularly, everything is unionized and everyone is focused
on personal rights and liberties. Employers are at the mercy of
government rules and employee whims. They work very little and expect
extensive social services, smoking cigarettes and drinking coffee, watching the
world walk by from neighborhood cafes. What sort of healthcare system
would these people want?
government-run, heavily social service oriented system that caters to a
leisurely lifestyle. Spa treatments, alternative medicines, herbalism all
thrive, but in order to keep people from overburdening the spas, copays for
many basic services run as high as 40% of the total bill.
the question is this: how would Americans respond to these other brands of
healthcare? If they were served up the Canadian system, they’d
scream at the tax rates, and become hysterical at the inability to trade up to
a platinum level of care for those who have “earned it.” They would not
accept the long lines for care and would immediately start a scheme for
off-shoring medicine to circumvent the lines.
Americans were offered the French system, they’d be immediately annoyed by the
inconvenience of the office hours (months of vacation are taken at a time by
all members of society, including doctors), they’d never use the preventive
health measures (they don’t have time for that stuff), and although they’d be
glad to receive home health aides for no more excuse than – “I just had a
baby and I’d like a government worker to clean my house” – when they saw the
tax rates it would take to make this available to all, they’d find it
unacceptable, especially with such high copays and out of pocket expenses..
socialized medicine will never work in the United States – not because it’s a
fundamentally flawed system, but because the American culture will not tolerate
it. Healthcare solutions are not globally applicable – (though I’d say
that from an IT perspective, there is an information sharing system that is
needed equally badly by all countries). Instead, systemic changes should
be personalized to the culture. Looking to other countries for magical
fixes to healthcare woes is like expecting that all cancers will respond to the
same chemotherapy regimen. Medical care is most effective when it is
customized to the individual, and healthcare reform will be most effective when
it takes into account the unique cultural values held by a country’s people.
In my next post, I’ll explain why health insurance companies
and big government health plans (Michael Moore’s solution to US healthcare
woes) share a common flaw.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.