It is not clear what message Frontline wanted to deliver in last night’s Sick Around America documentary. The show, conceived as a sequel to its acclaimed Sick Around the World special, was a limp, flat journalistic effort that did nothing to help the public understand the current politics of health reform. It both demagogued the insurance industry and then sent valentines their way, making me wonder if the show’s bad cop/good cop portrayal was a deliberate attempt to reflect the nation’s schizophrenic attitude toward the industry. In the end, it just made for a confusing and unfulfilling hour of television, and made me think that Frontline missed an opportunity to say something meaningful and new about the topic at hand.
The first half of the show piled on anecdote after anecdote about individuals’ experiences with health insurance. It was all familiar territory. We hear about a Microsoft employee whose super insurance paid a million dollars to help his premature infant survive. Then there was Paul Stevens, once a manager at a telecommunications company in Houston, who was in his late fifties when he lost his job. Stevens found COBRA too expensive and had to venture into the individual health insurance market where his diabetes disqualified him from coverage. When he had his heart attack, he had no insurance and got stuck with bills totaling more than $200,000. The Texas high risk pool was out of the question because it, too, was expensive and required a long wait for coverage. Stevens says he is trying to live long enough to get coverage from Medicare. But there was no talk of what problems await him once he gets there.
Interspersed among the stories are lessons about how the individual market works—sort of an actuarial primer for the public about medical underwriting. That’s the process of weeding out sick applicants for coverage. We hear about hundreds of people who declare bankruptcy each year, partly because of medical bills, and that others are hurt by a practice called rescission, where insurance companies drop those people whose applications failed to disclose all their medical conditions. The producer focused on California, where Los Angeles Times reporter Lisa Girion has written extensively about this subject. In Sicko, Michael Moore made the same point with a different carrier. Not much new territory here.
The documentary progressed to a discussion of consumer-directed health plans that, it said, were “loaded with caveats.” No kidding! Deductibles of $7500 or more and 40 percent coinsurance (that means you pay 40 percent of the medical bill) pinch the pocketbook, as Patricia Campbell of San Diego found out. OK, nothing new here either, as Campaign Desk has noted.
When the documentary addressed the subject of health insurance for everyone, it began by serving up a lot of confusion about health insurance provided through social insurance, as in Europe, and that provided by private carriers, as in the U.S. The narrator noted that many experts believe that a fairer system would cover everyone, just as all the other developed countries do for their citizens. He said that was “what insurers call guaranteed issue.” That’s a new one on me—referring to other countries’ social insurance systems as guaranteed issue. (When private insurers offer to guarantee coverage, they are saying they will do so generally without evaluating their applicants’ medical conditions.) Since there’s little private insurance in most of those countries, the concept doesn’t seem to track. There was no discussion of how social insurance works—that everyone pays taxes to fund health care; that everyone is guaranteed care as a matter of right; and that the national health systems pay for medical services in most cases, not private insurance companies.
I am sometimes accused of being overly frank, but in this case, perhaps I may be excused for noticing that there are almost no significant differences between health insurers as an industry and tape-worms.
To the extent that the Health Insurance Industry comes out happy or satisfied or comfortable with whatsoever negotiating process now ensues on the matter of health care, we, the people--we, who need treatment, repair, medication--we are harmed.
As long as the health insurance tapeworm is allowed to continue to reside in our national bowel, consuming nutrients, growing, reproducing itself endlessly, the sicker will grow the patients who suffer its intrusions.
Innit funny how Naomi Klein's 'shocks' never seem to work to liberate people, or to democratize institutions, or increase civil rights, but only to increase the authoritarian grip, the iron fist inside the velvet glove of the corporate media...
#1 Posted by Woody, CJR on Wed 1 Apr 2009 at 03:35 PM
Here's an interesting way to look at the problems with our prevailing pattern of employer-based health insurance: it amounts to an extremely complicated way of paying employees. Instead of just paying people in money, whose value is easy to understand, companies increasingly pay them in health coverage, whose value is complicated and hard to predict. So the employers aren't sure how much they're paying people, and the employees aren't sure how much they're being paid. Business is harder for everyone under this system.
#2 Posted by D. B., CJR on Thu 2 Apr 2009 at 10:04 AM
The only way to control costs and maintain quality health care is to eliminate for-profit private health plans. Other countries cover everyone and have as good or better medical outcomes as we have and spend half as much. The only difference is that we continue to have for-profit private health plans play central roles in financing health care. All other nations that are controlling costs and maintaining quality have either eliminated for-profit health plans as central players in health care financing or heavily regulate the private plans (i.e., can't make profits, can't exclude people, have to offer comprehensive, meaningful benefits, have to get permission to raise rates). Until we move to a single payer national health system, we will never control costs, quality will continue to erode, and more people will be uninsured and left to their fate. We don't need any more shows about how terrible our health care crisis is - we all know that. We need shows that take the time to examine and review the current health care reform proposals being considered, including single payer. We need details about costs, trade-offs, what the system would look like and what we would get. We need CBO and GAO giving us side by side comparison reports on the financing of the different proposals. When will media start doing their job and give Americans the accurate, substantial information they need to make this important decision about health care reform?
#3 Posted by Christine Adams, CJR on Thu 2 Apr 2009 at 02:34 PM
The example of the young woman who was allowed to die in Tennessee, which is repeated daily across this country, should be enough for Congress to hold hearings and grill the CEO's of the health insurance companies about their obscene million dollar profits off the backs of sick people through recissions. They are tantamount to murder. No one seems to be outraged by this. And some of these sick, greedy folks are doctors as shown by the program in total violation of their Hippocratic Oath to Do No Harm!! Why isn't there shock and outrage all across this country! The only humane, ethical, fair and cost-effective solution is Single Payer and the American doctors and public are ready for it. Obama and Congress are ignoring the thousands of emails for Single Payer to the whitehouse.gov site. We need a March on Washington before more people are murdered by neglect and conscious denials of care. There were no people of color or the poor even mentioned in this PBS documentary. They should be ashamed!
#4 Posted by Lynn Huidekoper,RN, CJR on Thu 2 Apr 2009 at 10:31 PM
Thank you for the commentary. Not only did Frontline not give single payer a voice in the program, they also cut off our ability to post comments by limiting the number of comments published. What is do scary, evil, or wrong with single payer that the words cannot be uttered or heard by the Administration? The single payer advocates, all two of them filled with their evil goal of trying to help people and not steal their money,were invited at the eleventh hour and were not allowed in the debate. The polls that I have seen show that single payer does have a great deal of support. I think that the healthcare system needs to rid itself of the parasitic tumor that feeds off the young and healthy and condemns the sick to death. I am glad that our forefathers took a chance and started the American Revolution. Innovative, courageous change is what we need now. The time for empty rhetoric is over. We aree our brothers' keepers.
#5 Posted by Pamella Gronemeyer,M.D., CJR on Fri 3 Apr 2009 at 12:02 AM
A big issue left out of Sick Around America...and out of pretty much the entire health care discussion ...is that the other part of the insurance business is investment---often in some of the top health damaging industries on the planet.
Some are: cigarette manufacturing, tobacco pesticides residues of which end up in typical cigarettes), pesticides in general (often made by pharmaceutical firms), oil, mountaintop removal coal mining, chlorine industries galore, and pretty much all the top military weapons manufacturers.
That is a patent conflict-of-interest, one that goes far to explain why we are inundated with studies and official concerns about illnesses related to our behavior, our genes, our diets and lack of exercise, germs, nature (including tobacco plants), too much sun, and the unknown. Only when it gets out of the bag do we see top level attention given to industrial causes of illness.
Our current for-profit system doesn't even think to check patients for body-burdens of pesticides, dioxins, depleted uranium, or other industrial toxins and carcinogens. How there can be a proper diagnosis of an illness, and then proper treatment, and then prevention, without determining the cause is a question.
This system is not only obscenely expensive, burdensome and unfair, it is a threat to everyone's health.
The idea of mandating patronage of this industry, and the incidental provision of revenue to such insurer investments, compounds the nightmare.
#6 Posted by John Jonik, CJR on Fri 3 Apr 2009 at 10:59 AM
Trudy, you missed the story. Reid quit, according to Russell Mokhiber in Counterpunch yesterday, precisely because the piece carried a deliberate lie by Karen Ignani, who knows that not all other countries with universal coverage require people to buy health plans from private insurers. He insisted the piece correct the record, according to Mokhiber's interview with Reid. Frontline refused. And they parted ways. That's a serious breach of journalistic ethics, isn't it? The producers at Frontline took a reporter's work, allowed an assertion he knew to be incorrect to run in the piece, refused to allow the reporter to correct that incorrect assertion with other evidence (reporting), and then still ran the piece after Reid refused to put his name on it. I think CJR needs to do another piece doublechecking Mokhiber's reporting, and calling the Frontline editors out on this if he is correct.
#7 Posted by Merrill Goozner, CJR on Fri 3 Apr 2009 at 02:45 PM
Excellent review. I was worked up enough to immediately go to the Frontline comment site and was pleasantly surprised that a lot of singlepayer advocates had beaten me to it. (My comment never made it in.) On thing I did mention was that I attended one of Kansas Gov. Kathleen Sebelius's privately funded Health Policy meetings six years ago. The group was heavily weighted with insurance types. These people LOVED cost cutting ideas. Why? Because they were going to shove all the extra cash in their pockets. The chance that any policy holder was going to get a break was nil. Needless to say, although, yes, we need to be looking for cost efficiencies, until we go to single payer nothing's gonna change.
Finally, Sen. Baucus and Pres. Obama, your Massachusetts rehash is too expensive, too complicated and too ineffective. H.R. 676!
#8 Posted by Vashti Winterburg, CJR on Fri 3 Apr 2009 at 06:30 PM
I caught that lie about foreign countries requiring everyone to be covered and then they can go out and get insurance, and I am afraid that is the point. The insurance companies are pushing for mandated insurance for all and the feds can susidize the poor. What was so clear from their previous program, that other countries may have health insurance, but it is either not-for-profit or the government controls cost of insurance and the competition is in doing it better than the other guy. That is lost in Sick in America, and about the only left is the insurance company message mandating coverage for all, with the feds picking up the tab for the sick and old. Then Medicare and Medicaid will really be in trouble.
#9 Posted by Norie Clarke, CJR on Fri 3 Apr 2009 at 10:48 PM
There is a scam of major proportions being brewed up by the insurance industry and it is the bait and switch of 'agreeing' to insure all Americans if legislation mandates that all must enroll.
This is heads I win, tails you lose proposition foisted by the industry. The problem is not getting insurance. The problem is that the actuarial odds are tilted wildly in favor of insurers such that coverage is unaffordable even for the least risky applicants.
I see parallels to the RIAA situation where an industry with no value to add other than extracting payments for standing in the middle of transactions will go down with the ship before relinquishing its ride on the gravy train. Frontline has failed miserably in being complicit to this kind of corporate sham.
#10 Posted by Xavier, CJR on Sun 5 Apr 2009 at 11:33 PM