One day last July, the Ottawa Citizen printed a cartoon called “The HMO Surgical Procedure”. It showed an unhappy soul on a gurney, glumly facing a cash machine marked “To open operating room doors, swipe credit card here”. The humour hit me as somewhat grim, and I whispered a muted ‘thanks’ to the ever-present spirit of Tommy Douglas.
Lyall A Higginson
That drawing turned out to be a well-timed prelude to Michael Moore’s satirical documentary, SiCKO, which I saw a few days later. I hope you rent the DVD if you missed the initial run. You should not be left behind in workplace conversations about this comparison of health care in the United States versus the systems in Canada, Cuba, England and France. Many of our colleagues saw the movie in July when film distributor Alliance Atlantis offered free passes to all Canadian nurses. Indeed, the Registered Nurses’ Association of Ontario hosted a screening for Liberal leader, Stéphane Dion, and Ontario’s Health Minister. The Association’s president, Dr Mary Ferguson-Pare, stated that if any politicians doubt the merits of our public health system, “this film will bring a healthy dose of reality”.
I agree with Dr Ferguson-Pare’s viewpoint, even though the movie’s impact was somewhat dampened by a number of shortcomings.
A flawed screen gem
For me, the main weakness in SiCKO lies in the error of omission, likely stemming from Moore’s fascination with entertainment at the expense of journalism. He paints in broad strokes and eschews shades of grey, doing his cause a disservice in the latter respect. Moore misinterprets the wait times issue and funding methods, and leaves out inconvenient details. This is most evident when he brings World Trade Centre cleanup veterans to Havana for treatment of lung problems and post-traumatic stress disorder. The average Cuban would be overjoyed to receive the high-quality care granted to the American contingent at Hospital Hermanos Almejeiras. Moore neglects to mention that the floor on which they were accommodated is dedicated to health care tourism, a currency-generation scheme geared toward attracting foreign patients.
For a more accurate picture of the services available to the Cuban people, look at the hospital photos at <www.therealcuba.com/Page10.htm>. I would not have believed this squalor if a consultant I know had not visited Hospital Joaquín Albarrán in Havana two years ago and discretely taken similar pictures. And if people think that they can walk into a Cuban hospital unannounced with their video cameras rolling, they are dreaming in technicolour. Moore’s visit had to be arranged through government officials who must have hoped to score a public relations coup for their nation. He fails to clarify this. The film would be more clearly focused and have fewer detractors if the Cuban segment had been left in the editing suite.
Although the director juxtaposes pathos and satire, the grim tone often dominates and the overarching theme is depressing. When you see impoverished humanity dumped from taxis along skid road, you may well feel that there is no political will at all to bring 50 million uninsured Americans under the umbrella of basic health care. Moreover, even people who already have insurance can be pummelled into bankruptcy by the stratospheric costs of treatment for cancer or other serious diseases. According to Moore (and innumerable research documents on the Internet), upward of one-half of America’s personal bankruptcies in recent years have been caused by medical care woes.
A ghost from the past
Among welcomed lighter moments, SiCKO features an excerpt from a recording produced by the American Medical Association. It stars a prepresidential Ronald Reagan. (Remember him from the 1951 classic, Bedtime for Bonzo?) In this paid engagement, he spooked Americans, with purple-prose warnings, that socialized health care would rob them of cherished freedoms. What SiCKO manages to do is convince the convincible that physicians who elect to operate under a public scheme are not pinko-docs earning factory worker wages in housing cooperatives. We can live very well, keep our patients well and reside darn well where we choose!
On another positive note, SiCKO excels in its capacity to stimulate debate about health care. Dare we hope that even a handful of politicians will grasp the torch anew and try to bring about a change in the corporate mindset that afflicts health care in the United States? If so, this would serve as the movie’s enduring legacy.
From our perspective, we can be grateful for a health care system that is on a reasonably sound foundation. However, gratitude must never be confused with complacency; this documentary can also be a launching pad for lively discussion on what remains to be done to improve Canada’s envied public system.
As cardiovascular professionals, we must still seek improvements to our own specialty and across the whole interlinked spectrum of health care. We need to renew the drive to lobby governments for sufficient financial and human resources. Our community has to be more proactive than ever and share the task of finding solutions and making them work. Under the Canadian system, we are able to play a part in monitoring our own standards and practices; we now need to build on this privilege to sustain the continuum of care we have laboured so hard to set in place. Let us embrace technology even closer – for instance, by bringing telemedicine to the forefront for patients who are unable to travel long distances. And why do we not offer referral hotlines to the public for up-to-the-minute status reports on wait times at emergency departments? If a computer-generated voice can tell us how long we must wait for a pizza delivery, can our resource-rich nation not do the same for the delivery of critical care? I invite you to attend the next Canadian Cardiovascular Congress in Quebec City, Quebec, and come to the workshop entitled “CCS benchmarks for access to cardiovascular services and procedures: A cross-country checkup and report card” on Tuesday, October 23, from 10:00 to 11:30, to learn about wait times for cardiovascular services. Join in a discussion to help us improve access to cardiovascular care.
Like Michael Moore’s newest release, our system has weak links within the overall structure. However, with each passing year, we will somehow manage to reinforce the Canadian health care system one component at a time. Perhaps it is because, as physicians, we are allowed to care about the people we care for.
The final frame
On August 16, I opened the Citizen to read this news from Kansas City, Missouri: “A husband, financially desperate because of his wife’s medical problem... walked his wife to the balcony outside their bedroom, kissed her goodbye and threw her to the street below. Her weight had dropped to 75 pounds… and she had an extensive history of traumatic brain injury, neurological disease, hypothyroidism and hydrocephalus. Her medical bills ranged from $700 to 800 US a week and she had no medical insurance”.
I am glad that I practise in Canada.