Kleurenschema: blauw - grijs

Moore shows urgent problems in the American health system, but offers an unrealistic solution

If you are an US citizen, and you have medical assurance, you might think that your medical expenses will be well covered. In that case, watching the documentary Sicko made by Michael Moore (2007) will have an unnerving effect. He shows many cases of insured Americans that do not get the care they need. According to Hacker (2007), the problem Sicko depicts is very real, but his solution of a free, universal health care is not realistic. The 1993 Clinton health plan failed, not only because the conservatives and the health industry attacked it, but also because there exists a ``deeply entrenched framework of insurance on which millions have come to rely, often quite happily despite the costs and hassles''. Hacker (2007) also questions why Moore pays so little attention to Medicare, ``our country's most popular and successful public insurance plan''.

America compared to other countries

It is indeed hard to reform the US care system. Peterson (2008) has reviewed a number of scholarly papers on the subject, and he concludes that the health care system is a ``mess''. The World Health Organization has ranked the US on the 37st place in its year 2000 ranking that is even worse than some less developed nations. So, although the need for improvement is clear, the way forward is not. A reform plan needs to take the current insurance system into account. Therefore, Hacker (2009) warns that a ``grand policy'' like the Clinton plan will not get far. The approach Obama has chosen, a ``real political compromise'', is already hard enough to realize in the current political situation.

Moore (2007) has compared the US system with Canada, the United Kingdom, France, and Cuba. He wonders why care in those countries is so much better, and he answers that question by pointing on their habit of helping each other. Moore is quite enthusiastic about national systems with universal access, but is such a system fitting for each country? The political attitudes of the public must be compatible with the health system. Kikuzawa, Olafsdottir & (2008) mention that ``health care systems worldwide are experiencing similar pressures such as rising cost, aging populations, and increased burden of disease''. The response to these problems are shaped by the window of public attitudes. Policy shapers should ``consider local pressures, particularly the implicit social contract between the state, medicine, and insurers''.

This is well exemplified by current developments in Europe. Although Europeans have had more socialized health systems, they currently are moving slightly towards more market-driven approaches because they hope to increase costs efficiency. For example, Mossialos, Saltman & (2002) describe European regulatory frameworks that enable private entepreneuring within national health systems. But the public attitude is still that access and availability of medical care should benefit everyone. Even the regulations for private entepreneuring are targeted to such goals as requiring that insurers accept all applicants.


Based on the documantary and the short summary I have given of some scholarly discussion, I have to agree with Moore that America has a serious problem and should change its health system. I also agree with Moore that many other countries have a system that provides care that is both of higher quality and of better availability for everyone. But his solution, just copying someone else's solution and implementing it in the US, attracks a lot of criticism, some of which I already mentioned. Changing an embedded health system is very difficult, it seems. Some authors point to the big differences with more socialized health systems in Europe, and how public attitudes shape national health systems.

Maybe Americans should not focus too much on the socialized aspects of current European health systems. It is natural to focus on the differences, especially on those fronts where Europeans do much better than Americans. But the most attainable goals for American change are more likely to be found in those parts of European care that are most similar to the American model.

Currently, many European nations are trying to create more room for private entrepreneurship and market mechanisms in healthcare. The European ideas on how to do this and how to regulate this, such as described by Mossialos, Saltman & (2002), are meant to minimize the disadvantages of capitalism in healthcare. That could be exactly what the Americans need. Examples such as requiring insurers to accept all persons and requiring hospitals to have staff available even at night could already relieve some of the problems so well depicted in Sicko.


About this document

Author Evert Mouw, post@evert.net
Date 2010-03-11
Institution UvA / Amsterdam Medical Center
Faculty Medical Informatics
Course Organizational settings of healthcare
Subject Assignment 1: Short Sicko review

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